Annals for Hospitalists - January 2023
Authors: David H. Wesorick
Journal: Annals of Internal Medicine (2023)

Web ExclusivesJanuary 2023Annals for Hospitalists - January 2023FREEDavid H. Wesorick, MDDavid H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202301170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Highlights of Recent Articles From Annals of Internal MedicineAnticoagulant Therapy for Cancer-Associated Thrombosis: A Cost-Effectiveness AnalysisAnn Intern Med. 2023;176:1-9. Published 27 December 2022. doi:10.7326/M22-1258In this study, the authors used data from a network meta-analysis in a Markov decision analytic model to determine the relative cost-effectiveness of enoxaparin, apixaban, rivaroxaban, and edoxaban in patients with cancer who develop venous thromboembolism (VTE). All of the direct oral anticoagulants (DOACs) were more cost-effective than enoxaparin, but the relative cost-effectiveness of the DOACs depended on the cost of the individual agents.Key points for hospitalists include:This analysis suggests that, in patients with cancer-associated thrombosis, the DOACs are likely to be more cost-effective than enoxaparin.The relative cost-effectiveness of the DOACs seems to depend on the actual cost of the individual agents, which can vary by region, pharmacy, and so forth.Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke: A Prospective Cohort StudyAnn Intern Med. 2023;176:39-48. Published 20 December 2022. doi:10.7326/M22-1638In this prospective cohort study, 4917 patients without history of stoke, atrial fibrillation, or anticoagulation underwent echocardiographic assessment of left atrial (LA) function to test if LA dysfunction might be associated with stroke risk. Some parameters (for example, LA reservoir strain) were linearly associated with ischemic stroke and, when added to CHA2DS2-VASc variables, improved stroke prediction.Key points for hospitalists include:These results suggest that echocardiographic data about LA function might be useful in estimating stroke risk, even in patients who have not yet developed atrial fibrillation. Editorialists note that the CHA2DS2-VASc score has not been validated in patients without atrial fibrillation, like those in this study. Therefore, the significance of the risk reclassification that was achieved by combining LA functional analysis with the CHA2DS2-VASc score in this study remains uncertain.Both the authors and the editorialists agree that further research is necessary to understand the role of LA functional analysis in determining stroke risk.Effects of Dapagliflozin on Hospitalizations in Patients With Chronic Kidney Disease: A Post Hoc Analysis of DAPA-CKDAnn Intern Med. 2023;176:59-66. Published 6 December 2022. doi:10.7326/M22-2115In this post hoc analysis of the DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) study, the authors examined the effect of dapagliflozin on the rate of hospitalization in patients with CKD (defined as an estimated glomerular filtration rate of 25 to 75 mL/min/1.73 m2 and a urinary albumin-creatinine ratio of 200 to 5000 mg/g). Patients randomly assigned to dapagliflozin had significantly reduced rates of both first hospitalization (hazard ratio, 0.84 [95% CI, 0.75 to 0.94]) and all hospitalizations or death (rate ratio, 0.79 [CI, 0.70 to 0.89]). This effect was not different in patients with or without diabetes.Key points for hospitalists include:In addition to the myriad established benefits of sodium–glucose cotransporter-2 inhibitors, it now seems that they are also associated with a reduction in hospitalization rates in patients with CKD.The authors point out that this post hoc analysis should only be viewed as “hypothesis-generating,” but this benefit might be expected to significantly reduce health care expenditures for this patient population.The Latest Highlights From Journal ClubDoes the addition of acetazolamide to loop diuretics improve diuresis?In acute decompensated HF, adding acetazolamide to IV loop diuretics reduced congestion at 3 dAnn Intern Med. 2022;175:JC136. doi:10.7326/J22-0095In this randomized controlled trial, 519 patients with acute decompensated heart failure were randomly assigned to either loop diuretic therapy (twice the home maintenance dose, intravenously, twice daily) or loop diuretic therapy plus 500 mg of intravenous acetazolamide daily. Significantly more patients in the acetazolamide group than in the loop diuretic only group achieved complete decongestion by day 3 (42% vs. 31%).Does aspirin or enoxaparin more effectively prevent VTE in joint replacement surgery?In THA or TKA, risk for symptomatic VTE was higher with aspirin vs. enoxaparin at 90 dAnn Intern Med. 2022;175:JC141. doi:10.7326/J22-0096In this cluster, crossover, randomized, controlled, noninferiority trial, 9711 patients undergoing total knee or hip arthroplasties for osteoarthritis were randomly assigned to either 100 mg of aspirin per day or 40 mg of subcutaneous enoxaparin per day. Aspirin did not meet the criteria for noninferiority, with patients treated with aspirin having higher rates of symptomatic VTE (3.5% vs. 1.8%). Most of the difference between the groups was driven by lower rates of below-knee deep venous thromboses in the enoxaparin group.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W.)Disclosures:Author has reported no disclosures of interest. Forms can be viewed at https://rmed.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2807.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics January 2023Volume 176, Issue 1 ePublished: 17 January 2023 Issue Published: January 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.Loading ...